Staying Healthy: The flu vaccine

It’s not just about protecting yourself

By Anna Zernone Giorgi/HealthyLife

Perhaps you never get sick. Or, you’re sure you can keep healthy with precautions. Maybe, you’re simply afraid of needles. Whatever your excuse for avoiding the flu vaccine, you may be risking the health and well-being of yourself and those close to you by ignoring the chance to get valuable protection against infection.

According to the Centers for Disease Control and Prevention (CDC,) the flu vaccine can reduce the rate of illness, antibiotic use, absence from work, hospitalizations, and even deaths related to flu infection. During the 2012-2013 flu season, vaccinated people were about 60 percent less likely to require treatment by a healthcare provider, reports the CDC.

“Although the flu vaccine is not perfect, it reduces your risk of getting the flu. It also reduces the severity of the flu if you happen to get it,” says Dr. Paul Sorum, a primary care physician board certified in internal medicine and pediatrics. He practices in Latham at Albany Medical Center Latham Internal Medicine and Pediatrics.

In addition, your vaccine may extend coverage to those around you. “It’s important to get the flu vaccine to protect your family and those close to you. This is especially important if there are babies or older people in the family,” Sorum says.

It’s crucial to protect the youngest members of the family because the vaccine isn’t administered to infants younger than six months of age. Older individuals need more protection because their ability to respond to the flu vaccine decreases around age 65. During a regular flu season, the CDC reports that about 90 percent of flu-related deaths involve people who are 65 or older.

The flu can cause a wide variety of responses, from mild to severe, and it can worsen quickly. It can cause serious complications in both healthy people and those with weakened immune systems. “In some cases, the flu itself is so bad and the body’s reaction to it is so bad that people can die from overwhelming pneumonia and the body’s reaction to it,” Sorum says. “The flu also can open the way for other bacteria, such as Staph aureus, to become a secondary invader, even in young people.”

Another important reason to get the flu vaccine is to prevent an epidemic, Sorum says. “If you get the flu, but the people around you are vaccinated, it stops there. If we can get enough stopping points so that, even though we may have some cases of flu in the community, we won’t reach an epidemic.”

The CDC has targeted an 80 percent flu immunization rate for people between 6 months and 64 years for the year 2020. In recent flu seasons, coverage has averaged about 40 percent nationwide. “If our community could get close to 80 percent, even if the flu were rampaging in other places, we could stop an epidemic from taking place here,” Sorum says.

How the Flu Vaccine Works

Flu “shots,” or immunizations that are given by injection, contain an inactive, or dead, form of the flu virus. The nasal-spray flu vaccine contains an attenuated, or weakened, form of the flu virus. Your body develops antibodies in reaction to the viruses in the vaccine. The antibodies protect your body against infection from those viruses in the future.

“All people 6 months and older are recommended to receive an influenza vaccination each year. Depending on vaccine type available to you, the 2013-2014 vaccine will protect against either three or four different influenza viruses,” says Jeffrey Hammond, spokesman for the New York State Department of Health.

The three most common categories of influenza viruses are: influenza A (H1N1) viruses, influenza A (H3N2) viruses, and influenza B viruses. Each year, the flu vaccine contains one specific virus from each category. Vaccines comprising three components are called trivalent. Some vaccines contain an additional influenza B virus. These four-component vaccines are called quadrivalent.

“Flu virus changes its structure every year — sometimes a little, sometimes a lot. This is how it evades our immune system. This is why people can become infected year after year. The World Health Organization in collaboration with the Centers for Disease Control monitors changes in the flu virus and recommends changes in the flu vaccine each year. This is why people should be immunized annually,” says Dr. Ronald Musto, a primary care physician board certified in internal medicine, occupational health, and medical examination. He practices in North Greenbush at Capital Healthcare Associates, a member of Community Care Physicians, PC.

The flu vaccines are formulated to provide protection for the entire flu season. “The best time to get vaccinated is as soon as the vaccine is available. You can still get a flu shot or the flu spray vaccine through the fall, winter or spring, since flu season usually peaks in February but continues through May,” Hammond says.

Remember that you are not fully protected until your body forms antibodies against the viruses, which may take about two weeks. Earlier vaccination is a priority if you have young children. “Children aged 6 months through 8 years of age who have never received a seasonal flu vaccine need to get two doses of vaccine spaced at least four weeks apart. This season, other children in this age group may need two doses as well,” Hammond says.

Which Vaccine is Right for You?

Several variations of the flu vaccine will be manufactured for the 2013-2014 flu season. Since some versions will be produced in smaller supplies, you’ll have the best chance of finding exactly what you want if you start shopping early in the season.

“Though some varieties of vaccine have been shown to produce a higher antibody response, no method of vaccine has been shown more effective than another in preventing influenza,” Musto says. “The most important choice is that you should be immunized.”

Most of the flu vaccine for the 2013-2014 season will be trivalent. Some quadrivalent vaccines also will be available. In addition, new formulations address specific needs. “Certain vaccine preparations by certain manufacturers have additional age restrictions, but at least one vaccine is available for all persons who qualify,” Musto says. (See sidebar.)

The standard trivalent intramuscular dose costs about $30 at pharmacies. Costs typically are higher for other versions. It’s also wise to check if your health insurance covers the cost of flu immunizations and if so, under what circumstances.

While this year’s offerings include more options, there still are some groups for whom immunization may be harmful. The CDC recommends that the following groups do not get a flu vaccine without the advice of a physician. This applies to people who:

Have a severe allergy to chicken eggs

Have had a severe reaction to an flu vaccine in the past

Are younger than 6 months of age

Have a moderate-to-severe illness with a fever

Have a history of Guillain–Barré Syndrome (a rare, but severe paralytic illness) that occurred within six weeks after receiving a previous flu vaccine

What to Expect After You’re Vaccinated

It’s not uncommon to experience some side effects from a flu vaccine. “The attenuated vaccine may cause mild cold-like symptoms. The inactivated vaccine may cause mild soreness at the injection site,” Musto says.

In some instances, you may feel that you’ve developed the flu as a result of the vaccine. “The flu vaccine is usually given at a time when there are other respiratory viruses going around. So, if you have a lot of people getting the flu vaccine and a lot of people getting sick, you’re likely to have people who get sick even after they get the flu vaccine, in which case, it’s just a different virus that they happen to come down with,” Sorum says. “Secondly, there are people who get bad reactions to some of the components of the vaccine.”

In other cases, you may get the flu simply because you were infected and didn’t know it at the time of immunization. If you were exposed to the flu virus before being vaccinated, or even before your body had the chance to produce enough antibodies after your vaccination, you could get sick with the flu.

While it’s not 100 percent effective, the flu vaccine is an important option for keeping you and your family healthy in the months ahead. “Influenza is not a trivial disease,” Musto says. “At worst, and especially in the sick and elderly, influenza causes over 150,000 hospitalizations and 30,000 deaths each year in the U.S. Getting immunized ourselves protects all those around us.”

Flu Vaccine Options

The following types of flu vaccines will be offered for the 2013-2014 flu season:

Trade names:Afluria, Fluarix, FluLaval, Fluvirin, and Fluzone: The majority of doses offered will consist of an inactivated flu vaccine in a standard trivalent dose. These vaccines are given with an intramuscular injection, which means that the shot is injected into a muscle. This version is available for ages 6 months and older.

Trade name:Fluzone Intradermal: An inactivated flu vaccine in a standard trivalent dose is available via intradermal injection for people 18 to 64 years old. An intradermal injection uses a needle that is 90 percent smaller than an intramuscular shot. It is injected into your skin.

Trade name:Fluzone High-Dose: An inactivated flu vaccine in a trivalent high dose is available in an intramuscular injection for people over age 65. This high-dose version addresses the fact that older people often don’t get adequate coverage from the standard dose.

Trade names: Fluarix Quadrivalent, FluLaval Quadrivalent, and Fluzone Quadrivalent: An inactivated flu vaccine in a quadrivalent standard dose is available via intramuscular injection for ages 6 months and older. This four-ingredient version includes an additional influenza B virus.

Trade name:Flublok: A recombinant inactivated flu vaccine in a standard trivalent dose is available via intramuscular injection for ages 18 to 49 years old. This egg-free version uses insect eggs instead of chicken eggs in manufacturing.

Trade name:Flucelvax: A cell-culture-based inactivated flu vaccine in a standard trivalent dose is available in an intramuscular injection for people age 18 and over. This egg-free version uses cultured animal cells instead of chicken eggs.

Trade name:FluMist Quadrivalent: A live-attenuated influenza vaccine in a quadrivalent nasal mist is available for people ages 2 through 49 years.

Photo: (c) Vstock LLC/GettyImages.

Where to Get the Vaccine You Want

When you’re ready to get your flu vaccine, starting at your physician’s office is best, but other options are available if cost and/or availability are issues. County health departments may sponsor free clinics. Other locations to investigate typically include urgent care centers, schools, employers, and pharmacies.

In New York, pharmacists who administer vaccines must be currently registered and certified to do so. By state law, certified pharmacists cannot administer the flu vaccine to anyone younger than 18 years of age. The restriction was temporarily lifted in January 2013 during last season’s flu epidemic, but it was reinstated in March.

One of the best ways to find a flu vaccine is by using the HealthMap Vaccine Finder at flushot.healthmap.org. Using your zip code, this online tool supplies mapped locations of nearby providers along with details on types of vaccines, hours, and phone numbers for each site. Since vaccine supplies can vary daily, it’s best to confirm availability at any site before going there.